Provider Demographics
NPI:1487615209
Name:OTWORTH, JAMES R (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:OTWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1805 27TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2686
Practice Address - Country:US
Practice Address - Phone:740-356-8231
Practice Address - Fax:710-356-3686
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21422207L00000X
OH34004394207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08825018Medicaid
AL140216Medicaid
OH0843985Medicaid
F01448Medicare UPIN
MS08825018Medicaid
MS302I050413Medicare PIN
OH0843985Medicaid